02-14-2010, 10:59 AM
14. A 42-year-old African-American man with hepatitis C is admitted to the hospital for evaluation of a 3-day history of fever and right upper quadrant abdominal pain. The pain is steady and does not change with position. He has had associated nausea but has not vomited. He has a history of alcohol dependence but has not had an alcoholic beverage since being diagnosed with hepatitis C 4 years ago. He does not take any medications. On admission, vital signs are: temperature 38.5°C (101.3°F), pulse 115/min, respirations 24/min and blood pressure 100/60 mm Hg. Physical examination shows scleral icterus. Abdominal examination discloses mild distention and right upper quadrant tenderness to palpation; the liver spans 25 cm. There is no rebound tenderness and bowel sounds are normal. Ultrasonography of the right upper quadrant shows three small gallstones, dilated right and left intrahepatic ducts and normal common bile duct. Laboratory studies show: Serum Blood ALT 650 U/L Hematocrit 35% AST 442 U/L WBC 22,000/mm3 Alkaline phosphatase 342 U/L PT 14 sec Bilirubin 7.0 mg/dL PTT 28 sec Na+ 140 mEq/L INR 1.2 K+ 4.2 mEq/L Cl- 104 mEq/L HCO3- 23 mEq/L Fluid resuscitation is begun. Which of the following is the most appropriate next step? A) Biopsy of the liver ?B) Cholecystectomy C) CT scan of the abdomen [D) Endoscopic retrograde cholangiopancreatography with st]
Key says B or C or D?
Key says B or C or D?